HIAA, Families USA and AHA Unite to Solve Problem of Uninsured
Putting aside several years of feuding, three "strange bedfellows" -- the Health Insurance Association of America, Families USA and the American Hospital Association -- came together at a press conference yesterday to unveil a joint proposal to halve the number of uninsured Americans. The plan takes a three-pronged approach, calling for expanding Medicaid to people under 65 earning up to 133% of the federal poverty level; allowing states to expand CHIP program coverage to certain adults; and establishing tax credits for businesses to encourage them to provide coverage to workers. "As organizations representing the breadth of the health care community, we stand together to forge common ground to end the gridlock over extending health care coverage to the uninsured millions living in America today," the three organizations announced in a joint press release. Calling for an end to "partisan, ideological and interest-group boundaries," Families USA Executive Director Ron Pollack emphasized the need for cooperation in crafting proposals that would give health coverage to more individuals. "Political gridlock should no longer be an option in dealing with America's uninsurance epidemic," he said. HIAA President Chip Kahn said, "In the past, every group interested in extending coverage to the uninsured held out for their favorite approach, and their second choice always was the status quo. As a result, nothing was accomplished." Rick Pollack, executive vice president of the AHA, added, "With this step, we've laid a strong foundation we hope to build upon to improve access and coverage for all" (HIAA/Families USA/AHA release, 11/20). Although Kahn and Ron Pollack conceded that the new proposal "is not the optimum strategy for either organization," they said that "past reform battles" have taught them that "an ideal will only result in stalemate" (Health Affairs release, 11/20). Pollack, Kahn and Rick Pollack also outlined their proposal in a letter to House Speaker Dennis Hastert (R-Ill.), calling on the government to "use good economic times to address this problem" (Kahn et al., letter, 11/20).
At yesterday's press conference, the three leaders outlined five basic guiding principles on which their plan was founded:
- that providing universal coverage will be accomplished "neither through modest increments nor through one comprehensive package," but through a "step-by-step" approach;
- that the plan "cannot take away, or appear to take away" coverage from those who currently have it;
- that the guidelines should build on existing health coverage structures, both public and private; thus avoiding the creation of new bureaucracies and "further fragmentation of the health system;"
- that the plan should use public resources in a way that "maximizes new health coverage";
- that the proposal focus on low-wage workers, their families and other low-income individuals who are "least capable of obtaining health coverage."
The proposal is composed of three parts and focuses mainly on individuals and families earning below 200% of the federal poverty level. The plan would first require an expansion of Medicaid to include all people under 65 earning below 133% of the FPL. Eligibility for this coverage would be based exclusively on income; individuals would no longer need to belong to one of "several prescribed categories," such as children or parents. Secondly, states would have the option of opening "Medicaid or S-CHIP-type coverage" for adults under 65 earning between 133% and 200% of the FPL. Eligibility for these programs would also be based on income, not parental status. "[S]ignificantly enhanced" federal matching funds would be made available for these programs. Third, the plan would establish a non-refundable tax credit for businesses to "encourage them to make employment-based coverage more affordable for their low-income workers." This credit "should be established in tandem" with creation or expansion of the Medicaid-type programs for people earning between 133% and 200% of the FPL, and would be available to employers who pay a larger share of insurance premiums for workers earning 133%-200% of the FPL than they do for other workers in the company. Pollack, Kahn and Pollack said they believe the plan "achieves a reasonable balance between public sector and private sector approaches" (Kahn et al., "Finding Common Ground for Expanded Health Coverage to the Uninsured," 11/20). However, they stressed that the guidelines are not meant to be concrete legislative initiatives. "This agreement is a policy framework, not a set of legislative specifications," Ron Pollack said. He added that the plan has gotten a "very positive response" from businesses concerning the tax credit option. Although a supplemental survey estimated the cost of the plan at $250 billion, Kahn said yesterday that no definite cost has been calculated yet for the proposal. "We haven't done a cost estimate, and partly because ... this is a policy framework." Kahn added that $250 billion was a figure "roughed out" for survey purposes, but he "wouldn't stand by" those numbers. "I think without any question, we are talking about a significant magnitude of dollars," he said (Meredith McGroarty, California Healthline, 11/21). To view a copy of the proposal, please go to http://membership.hiaa.org/pdfs/001120CommonGround.pdf. Kahn and Ron Pollack have also outlined their proposal in an article appearing in the January/February 2001 issue of Health Affairs.
The joint proposal makes "strange bedfellows" of the HIAA and Families USA, since the two groups were once "archenemies in the fight over national health care," the Washington Post reports. Their differences came to a head in 1994, when the two groups sparred over President Clinton's plans for universal health care and became involved in "some of the nastiest exchanges" over the issue. HIAA staged a $15 million campaign, which included the "Harry and Louise" television ads, to sink Clinton's plan, while Families USA "championed" the measures. Pollack said, "Chip Kahn and I can't recall ever agreeing to anything" (Pianin, Washington Post, 11/21). HIAA, a trade group composed of health insurance companies, has traditionally favored bolstering coverage through the private sector and adopting more "modest" Medicaid and CHIP expansions as a measure to reduce the number of the uninsured. Families USA, a health care consumer advocacy group, has "never favored tax incentives" as a way to combat the problem, instead leaning instead toward shoring up Medicaid and CHIP (Health Affairs release, 11/20). Earlier this year, however, Kahn and Pollack both participated in a conference sponsored by the Robert Wood Johnson Foundation and realized they had some ideas in common (Washington Post, 11/21). The proposal put forward yesterday follows a year of efforts by the two organizations to forge feasible guidelines that incorporate aspects of both groups' strategies (McGroarty, California Healthline, 11/21).
Between Nov. 11 and Nov. 13, the polling firm Public Opinion Strategies conducted a national survey on expanding health coverage to the uninsured, the findings of which were released at the conference yesterday. The poll, which surveyed 800 adults, found that "[t]here is substantial public support for significant reforms to help reduce the number of uninsured Americans." While 46% of the respondents "strongly favor" expanding Medicaid, 82% generally favor augmenting the program. In addition, 48% of the respondents "strongly favor" and 83% generally favor expanding CHIP to "working poor adults." Eighty percent of participants said they would recommend to their member of Congress to favor a $250 billion program similar to the one proposed by the three organizations and funded by the federal surplus. In addition, 55% of those surveyed said they would even support this program at an increase of $200 per year per taxpayer (Public Opinion Strategies survey, 11/20). The survey can be viewed as a Power Point presentation on the HIAA Web site at http://www.hiaa.org/news/news-state/001120mediakit.htm.
The three leaders believe the plan "could garner support from a broad spectrum of groups and legislators" (Health Affairs release, 11/20). The plan has received support from White House officials, including Clinton health care adviser Chris Jennings, who called it "encouraging" (McGinley, Wall Street Journal, 11/21). The collaborative approach of the two groups is also receiving "generally positive early reviews on Capitol Hill," the New Orleans Times-Picayune reports. Sen. John Breaux (D-La.) said, "This is more of a political breakthrough than a policy breakthrough. It could be very helpful to Congress. Traditionally, these groups have been on opposite sides, and they have strong constituents" (Walsh, New Orleans Times-Picayune, 11/21). Sen. Edward Kennedy (D-Mass.) also lauded the groups' efforts. "The fact that these three respected organizations agree on a plan to expand health insurance coverage is an excellent sign that bipartisan cooperation and progress are possible on this important issue next year" (Pear, New York Times, 11/21). But the plan is getting its share of criticism as well. Neil Trautwein, director of employment policy for the National Association of Manufacturers, labeled the plan a "big-government approach" (Wall Street Journal, 11/21). The California Nurses Association said the plan has "serious flaws," with President Kay McVay saying, "[T]his half-baked plan won't get us to universal health coverage. It veers far off course by linking a sound program, Medicaid, to flawed plans like CHIP and the highly risky use of tax credits" (CNA release, 11/20). In a letter to California Healthline, Don McCanne, a member of the board of Physicians for a National Health Program, criticized Pollack and Kahn for jettisoning their "ideal" strategies in favor of a compromised approach. "The rejection of 'ideal' reform based on political expediency must be challenged," he said. McCanne also criticized HIAA for supporting a "morally corrupt industry" which "is designed specifically to divert our health care dollars to their own coffers" (McCanne letter, 11/21).